Source 1 Critique

Source 1

Cost-Utility Analysis: Use QUALYs Only With Great Caution
McGregor, M. (2003, February 18). Cost-utility analysis: Use QUALYs only with great caution. Canadian Medical Association Journal, 168, 4.

Cost Utility Analysis

Purpose
This commentary in the medical journal specifically addresses the use of QUALYs (Quality Adjusted Life Year) and the limitations and possible pitfalls that are associated with the unit of measurement. The article uses specific examples to outline some areas which could cause confusion if using QUALYs.

Strengths and Weaknesses
   Strengths:

• Allows for a single unit of measurement to compare different health outcomes
• Compares direct dollar costs to different health outcomes
• Benefits the decision maker

   Weaknesses:

•  Understandability by the user
•  Validity in measuring what is intended
• Reliability and repeatability
• Applicability to the affected population

Description
The article did not specifically explain the process of using cost utility analysis, but did summarize the method. To compare different health outcomes within an economic frame of mind, a calculation results in QUALYs. Using a scale from 0 to 1 (where 0 is imminent death and 1 is perfect health), the method of cost utility analysis (CUA) calculates the outcome of any health intervention and compares their effectiveness in QUALYs versus monetary cost for such an intervention. The higher the QUALY measurement is, the higher the priority given to the corresponding health intervention.

Uses
Problems which are targeted by the cost utility analysis method are generally economically related health care issues and interventions. It allows decision makers the ability to mathematically compare otherwise qualitative information in a quantitative method. There are downsides to the use of CUA, which revolve around the issue that certain QUALY measurements misrepresent the legitimacy of the intervention in question. An example used by the author is that treatment for erectile dysfunction, although less cost-prohibitive than renal dialysis or coronary bypass, is also less important in the bigger picture of life-saving medical practice. The CUA, if strictly adhered to, would disagree and dictate that the correct medical administrative practice is to allocate resources to correcting erectile dysfunction instead of saving lives.

Sources Cited
The author of the commentary listed the following sources:

·       Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost–effectiveness in health and medicine. Oxford: Oxford University Press; 1996.

·       Drummond M, McGuire A. Economic evaluation in health care. Merging theory with practice. Oxford: Oxford University Press; 2001.

·       Smith KJ, Roberts MS. The cost–effectiveness of sildenafil. Ann Intern Med 2000; 132:933-7.

·       Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost–effectiveness in health and medicine. Oxford: Oxford University Press; 1996. p. 8.

·       Nord E. Cost–value analysis in health care. Making sense out of QALYs. New York: Cambridge University Press; 1999.

·       Volk RJ, Cantor SB, Spann SJ, Cass AR, Cardenas MP, Warren MM. Preferences of husbands and wives for prostate cancer screening. Arch Fam Med 1997; 6:2-78.

·       Drummond M, Torrance T, Mason J. Cost–effectiveness league tables: More harm than good? Soc Sci Med 1993;37:33-40.

·       Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost–effectiveness in health and medicine. Oxford: Oxford University Press; 1996. p. 119.

·       Read JL, Quinn RJ, Berwick DM, Fineberg HV, Weinstein MC. Preferences for health outcomes. Comparison of assessment methods. Med Decis Making 1984; 4(3):315-29.

·       Groome PA, Hutchinson TA, Tousignant P, Hanley JA. The repeatability of three methods for measuring prospective patients' values in the context of treatment for end-stage renal failure. J Clin Epidemiol 1999;52(9):849-60.

·       Fleming C, Wasson JH, Albertsen PC, Barry MJ, Wennberg JE. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. JAMA 1993;269:2650-8.                             Krahn MD, Mahoney JE, Eckman MH, Trachtenberg J, Pauker SG, Detsky AS. Screening for prostate cancer. A decision analytic view. JAMA 1994; 272: 773-80.

Most Informative
The most informative takeaway of this article is that the questions of validity, reliability, and relevancy of the CUA process must be addressed when providing the results to decision makers as a final product. To ensure that all information pertaining to the problem and recommended solutions are understood, plain speak (verbally describing the results) should be used in addition to QUALYs.

Source Author
Dr. Maurice McGregor is a cardiologist, professor at McGill University in Canada, and is a founding board member of the Canadian Coordinating Office for Health Technology Assessment. Dr. McGregor has been practicing in the medical field for over 60 years and has military experience as well. As the author of this article, Dr. McGregor has more than adequate knowledge, experience, and influence regarding the subject matter and is a very reliable source regarding the use of CUA.

Source Reliability
According to the Dax Norman Trust Evaluation Worksheet for online sources, the source has a Very High Reliability rating.

Critique Author
Mark L.

sapperlt@gmail.com,

Mercyhurst College, Erie PA,

Advanced Analytic Techniques Course

January 4, 2011